Have you ever pled guilty to or been convicted of a crime other than a routine traffic violation?

Yes

No

If Yes, list date and nature of guilty plea conviction in the box below.

SKILLS, EXPERIENCE & SPECIAL TRAINING

Do you have experience operating a cash register?

Yes

No

Do you have any customer service experience?

Yes

No

Please list any special qualifications, business equipment operating abilities, training, education, skills, or experience that you feel warrant consideration by the company.

EDUCATION

Did you graduate from high school or earn a GED?

Yes

No

Name and location of college, university, business or trade school?

Degree Earned?

Yes

No

Type of Degree?

Major field of study?

WORK EXPERIENCE

May we contact your present employer?

Yes

No

Name of present or last employer?

Type of business?

Address

Street AddressCityState / Province / Region

Starting date of employment?

Ending date of employment?

Starting Salary?

Leaving Salary?

Were you fired?

Yes

No

Job title?

Name of supervisor?

Job Description and Responsibilities?

Explain reasons/circumstances for changing or wanting to change jobs

If we contact this employer, would you expect them to say they would rehire you for a position you last held there?

Yes

No

If no, please explain

Employer's phone number ex (999) 999-9999

Name of employer prior to job above?

Type of business?

Address

Street AddressCityState / Province / Region

Starting date of employment?

Ending date of employment?

Starting Salary?

Leaving Salary?

Were you fired?

Yes

No

Job title?

Name of supervisor?

Job Description and Responsibilities?

Explain reasons/circumstances for changing or wanting to change jobs

If we contact this employer, would you expect them to say they would rehire you for a position you last held there?

Yes

No

If no, please explain

Employer's phone number ex (999) 999-9999

Name of employer prior to job above?

Type of business?

Address

Street AddressCityState / Province / Region

Starting date of employment?

Ending date of employment?

Starting Salary?

Leaving Salary?

Were you fired?

Yes

No

Job title?

Name of supervisor?

Job Description and Responsibilities?

Explain reasons/circumstances for changing or wanting to change jobs

If we contact this employer, would you expect them to say they would rehire you for a position you last held there?

Yes

No

If no, please explain

Employer's phone number ex (999) 999-9999

COMMENTS

If you have anything else you would like to add please type them in the box below.

How did you hear about this position?*

CERTIFICATION AND AGREEMENT

I certify that the facts set forth in this Application For Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application could lead to disciplinary action including dismissal. I understand that the Company will run a credit check on me. The Company is hereby authorized to investigate any of the facts set forth in this application. I understand that employment at this Company is "at will," which means that either I or the Company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager or executive of the Company, other than the President, has any authority to alter the foregoing.*